Anesthetic Overdose Leading to Cardiac Arrest Diagnosed by End-Tidal Inhalant Concentration Analysis in a Dog

Abstract

A 5-year-old male-castrated Cocker Spaniel presented to the Veterinary Teaching Hospital of the University of Georgia for a total ear canal ablation. Premedication was with carprofen 2.2 mg/kg SQ, hydromorphone 0.1 mg/kg IM, diazepam 0.2 mg/kg IM, and glycopyrrolate 0.01 mg/kg IM. The patient was induced with lidocaine 2 mg/kg IV and etomidate 1 mg/kg IV and maintained with sevoflurane and a constant rate infusion consisting of lidocaine 0.05 mg/kg/min. Before surgery start, the patient's systolic arterial blood pressure was 110 mmHg, heart rate (HR) was 85 beats/min, respiratory rate was 8 breaths/min, end-tidal sevoflurane concentration was 3.2%, and end-tidal CO 2 (ETCO 2 ) was 23 mmHg. As a scrub was being performed, the patient's HR abruptly dropped to 20 beats/min over the course of 2 minutes. His ETCO 2 simultaneously decreased to 16 mmHg. At this time, cardiopulmonary arrest was diagnosed. After two minutes of resuscitation, a spontaneous heart beat was obtained and the patient was successfully recovered and discharged without further incident. The cardiac arrest in this case is most likely attributable to an overdose of inhalant anesthesia, which was diagnosed by an anesthetic inhalant concentration monitor. A gas analyzer may be a helpful contribution to the small animal practitioner, particularly those performing more lengthy or complex procedures.